In Australia, rotavirus gastroenteritis is a frequent cause of hospital admission, and outbreaks of the disease wreak havoc among preschool children. Worldwide it is an important cause of death in the very young. As evidenced by Schultz’s findings for the Northern Territory (→ Rotavirus gastroenteritis in the Northern Territory, 1995-2004), it’s a fairly common disease, whose incidence is even higher in Indigenous communities. Two vaccines are now available in Australia, and the NT Government has announced funding for routine vaccination of all infants. Will the other states follow suit? Barnes and Bishop (→ Rotavirus vaccine — time to act) are optimistic.
Authorised or traumatised
Often de-humanisingly referred to as “unauthorised arrivals”, asylum seekers who arrive in Australia without valid travel documents, even if eventually deemed to be valid refugees, are issued with temporary (rather than permanent) protection visas (TPVs). TPV holders must prove their continued need for protection every 3-5 years, cannot leave Australia for any reason, cannot sponsor relatives to join them, and have limited access to refugee education and employment services. Critics of this system say that living with the uncertainty of these arrangements can only mean further trauma for people who have been traumatised and persecuted in the past. Momartin et al put this theory to the test in a study comparing the mental health of two groups of Persian-speaking refugees — one with permanent protection and the other with TPVs (→ A comparison of the mental health of refugees with temporary versus permanent protection visas).
With a wide range of presentations and potential outcomes, food allergy can be a confusing topic for the generalist. Yet scientific evidence confirms anecdotal impressions that allergies to food are on the increase. The latest article in our MJA Practice Essentials — Allergy series (Allen et al, “4. Food allergy in childhood”) provides a rational and up-to-date approach to this problem. And you may not have heard of the condition described by Kakakios and Heine in the related Focus article (→ Eosinophilic oesophagitis). Eosinophilic oesophagitis is an emerging manifestation of food allergy that can be particularly problematic.
Jumping the gun
The Medical Services Advisory Committee recently recommended that Medicare fund vertebroplasty for patients with osteoporotic spinal fractures. While the funding of new procedures is usually welcome, Buchbinder and Osborne (→ Vertebroplasty: a promising but as yet unproven intervention for painful osteoporotic spinal fractures) urge caution until all the evidence on this promising intervention has been collected.
Have you ever had the urge, while working a long and lonely night shift, to slip into an empty bed for a bit of a kip? Well next time it strikes, you might be vindicated. According to McEvoy and Lack, a short nap on night shift might not be such a bad idea (→ Medical staff working the night shift: can naps help?).
What should the mainstream medical profession think and do about complementary and alternative therapies? Several articles in this issue will inform the debate surrounding this question. In the realm of child and adolescent psychiatry, where medication is not recommended as first-line treatment for depression, there is a range of complementary and self-help treatments available. In “Effectiveness of complementary and self-help treatments for depression in children and adolescents”, Jorm et al present a systematic review of studies addressing their effectiveness. Mainstream and alternative therapies often overlap in the management of cancer and in palliative care, but according to Robotin and Penman (→ Integrating complementary therapies into mainstream cancer care: which way forward?) there is work to be done before they can be integrated. Sanderson et al (→ The "therapeutic footprint" of medical, complementary and alternative therapies and a doctor’s duty of care) acknowledge the difficulties inherent in considering the very different approaches of the two camps on the same page, but present a way forward in the guise of a “therapeutic footprint” in which the risks and benefits of both the medical and the alternative treatments can be considered together. Finally, a Notable case presented by See et al (→ Accidental death from acute selenium poisoning) illustrates what can happen when the mainstream and alternative worlds are so polarised that patients pursue their own diagnoses and treatment on the Internet.
Raising the stakes
Australia is no slouch when it comes to health and medical research output. However, after a few years of lagging behind other developed countries in our research investment, the federal government in its May budget did its best to tip the balance back in our direction. Khachigian gives the details in “Health and medical research funding: an investment in Australia’s future”.
Another time . . . another place
It may . . . come to pass that someday the person who drives or goes to work while sleepy will be viewed as being as reprehensible, dangerous, or even criminally negligent as the person who drives or goes to work while drunk. If so, perhaps the rest of us can all sleep a little bit more soundly.